for exogenous poisons and intoxicants are THE SAME as those of serious mental disorders such as bipolar illness and schizophrenia and other dementias; severe depression, unexplained continuous fear and anxiety, loss of appetite, involuntary loss of weight, inability to sleep, malaise, fatigue, motor slowing, motor excitement and hyperactivity, paranoia, hallucinations,psychosis, delirium, dementia, altered mental status….all recognizable as neurotoxic symptoms.
Anything can be a poison and have neurotoxic effects. Water, air, food, all necessary but if too much, if too little, all can be a poison. We may experience neurotoxic effects due to endogenous issues that we know nothing about. I think that this is what happens in psychiatric illness, particularly in bipolar illness.
Air can be a poison. Not only the quality of the air we breathe but the way we process the air we breathe and the way we process the products of eating the food, which interestingly enough, becomes internal carbon dioxide through metabolism,…internal endogenous carbon dioxide, a gas, which we must keep in check..
Breathing rate, depth and pattern at rest will give us a baseline of how this system is working. Yet everyone assumes that breathing rate, depth and pattern is normal. This is because breathing rate, depth and pattern is set by the brain stem in partnership with the peripheral systems of the body [the blood, lungs, and skeletal respiratory muscles] in order to maintain the chemical balance of gases inside the body. The ventilatory system can look normal even when it is not. It is not easy to detect ventilatory failure.
Kraepelin’s studies and the case study of Paula [described in earlier blog posts] point to weakening of ventilatory skeletal muscle as a factor in the pattern of neurotoxic effects of bipolar attacks.
The ventilatory skeletal muscle [and peripheral nerve] system is vital in moving air in and out of our bodies in sufficient amounts and in the proper ratio’s. The lungs themselves have no muscle and rely on the skeletal muscles for air.
We often forget, but the skeletal muscle system is part of breathing. And difficulty breathing, whether obvious or not, can lead to imbalance in gas exchange despite healthy lungs. And imbalance in gas exchange can lead to altered mental status and symptoms of neurotoxicity. And if the difficulty breathing persists, whether during the day or during sleep, or both, the neurotoxic symptoms will increase, up to and including, psychosis.
The skeletal muscle system is one of the vital systems which stand between mental health and mental illness, between sanity and madness.
We ignore the state of the skeletal muscle system in the motor act of breathing to our peril, especially in people who have become insane and unable to care for themselves.
The next blogpost discusses the effects of insomnia and sleep deprivation on the respiratory muscles.